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Re: Insurance

Posted by - Sleepy Coote on December 19, 2002 at 07:08:09:

In Reply to: Insurance posted by LuLu on December 18, 2002 at 16:45:48:

If your insurance is from an employer, mention your dilemma to their benefits or human resources. Maybe they can get a printed copy for you, if one exists. In an earlier post Janey also mentioned utilizing your state's Insurance Commission.

I do wonder if insurance companies are even required to have a printed disbursement statement about each and every possible medical remedy, however. I was kind of under the immpression that they were at liberty to make reasonable and accurate judgement calls about "medical necessity"---and it was up to us to provide them with doctor-written statements of "medical necessity" which they frequently reject anyway.
In my state it seems that I must exhaust the internal appeals process offered by the insurance company before I can go to the Illinois Department of Insurance. Beyond that the Illinois Department of Insurance will force the insurance company to review the denial at the highest levels of the company---but nothing more beyond that. The state will not medically evaluate the claim.

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